Healthcare Provider Details

I. General information

NPI: 1598743064
Provider Name (Legal Business Name): HELENA LAX-KAMENICKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 RACE ST
PHILADELPHIA PA
19102-1125
US

IV. Provider business mailing address

1513 RACE ST
PHILADELPHIA PA
19102-1125
US

V. Phone/Fax

Practice location:
  • Phone: 215-587-3056
  • Fax: 215-587-9405
Mailing address:
  • Phone: 215-587-3056
  • Fax: 215-587-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD070391L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: